FUTURE CHALLENGES IN BIOMEDICAL ENGINEERING

(Source:
International Council of Academies of Engineering and Technological Sciences, Inc. (CAETS)
http://www.caets.org/ )

A man with a new prosthetic arm can ‘feel’ things and thereby grip eggs without breaking them. His
prosthesis has a computer in the forearm that is wired to a mechanical hand and to a "plunger" device on
his chest. The hand sends signals up the wires to the plunger, which pushes the skin. That stimulates
nerves in his chest, which have been rewired there from where they used to be in the upper arm, to
transmit sensations to the brain as if the nerves were still connected to his real hand.

This is just one example of the amazing progress that has been made in medical science over the last
few decades. This progress has come hand in hand with technological advancements in electronic and
mechanical engineering, computer science, and information and communication technologies (ICT). The
blending of all these fields is biomedical engineering, the application of the principles of engineering to the
solution of problems in biology and medicine. A biomedical engineer is positioned to work at the
intersection of engineering, mathematics, physics, biology, and medicine to solve real world
problems.

Evidence of biomedical engineering can be found everywhere in modern medicine. Hospitals are full of
devices, instruments and machines that have been designed and produced by engineers working in
collaboration with doctors, nurses, biochemists, physicists, microbiologists and technicians. Examples
range from the pumps that administer drugs to patients, to instruments that monitor heart rates and other
vital functions, to complicated scanners that produce detailed three-dimensional images of internal body
structures. Biomedical engineering devices are also involved in many kinds of treatments, including
implanted pacemakers that maintain the function of the heart, artificial joints that replace those damaged
by disease or injury, and synthetic blood vessels.

Progress in biomedical engineering has never been more rapid and exciting than it is today. This
progress is driven both by the identification of problems that need to be solved - "clinical pull" - or by the
invention of new tools, the application of which may move medicine into new areas - "technology push".
Present research indicates that the field will continue expanding and growing at high rates with
numerous amazing contributions to public and individual health. Innovations will continue to
revolutionize clinical practice whether by providing solutions to the challenges of obtaining fast
and reliable diagnoses, providing less traumatic therapies, managing the ever increasing volumes
of data, or discovering and developing radical new technologies which lead to completely novel
procedures. Specific advances could include storage of genetic profiles in a database accessible to
doctors nationwide. People may live in smart houses equipped with sensors to monitor the status of their
general health. Everyone may have access to regular non-invasive screenings to detect disease as early
as possible. Efficient noninvasive sensor-based procedures may also monitor and evaluate
cardiovascular and musculoskeletal system health.

A call to emergency services in the year 2050 will bring a new kind of ambulance to the door. The
ambulance will be equipped to assess patient status more thoroughly using on-board blood analysis,
scanners and computer diagnoses to facilitate proper and efficient patient handling during transport and
upon arrival at the hospital. Once at the hospital, advanced scanners will make clear and realistic
pictures of the inside of the body, which will be supplemented by information from laboratory tests using
automated analyzers. The treatment which the patient receives will be determined by computer,
balancing the costs against the benefits, and following evidence-based ethical protocols. Internal and
external sensors will be able to continuously measure response to treatment. Many of the people who
look after the patient will not be medically qualified but will be highly skilled technicians trained in
specialized diagnostic and therapeutic devices and procedures. The doctors and all the other medical
staff will have access to clinical data through hand-held wireless personal digital assistants, avoiding
information overload and protecting the confidentiality of the patients.

1
If surgical intervention should be necessary, it will be performed by image-guided robotic instruments,
which will be programmed and run by surgeons perhaps not even in the same room. The air in the
operating room will be filtered and cleaned to be virtually free from infectious agents so that the risk of
contamination will be trivial. The anesthetic agents will be automatically delivered to maintain the patient
at the optimal level of awareness by feedback control from sensors in and on the body. If body parts
need to be replaced, this will be with biologically-compatible engineered systems made either from living
tissue or from artificial materials. Most procedures will cause little or no trauma to the patient, who will not
even have to stay in the hospital overnight. Post-operative assistive and rehabilitation technologies, such
as artificial limbs and wheelchairs, will be greatly advanced, enabling patients full range of mobility and
sensation. The earlier story of the mechanical, feeling prosthesis is just the tip of the iceberg.

Outside of the hospital, health and medicine will be managed via a virtual medical world. With sensors in
the home and access to a "cyberphysician", many routine office visits may be eliminated. The
cyberphysician will also be able to guide patients through the management of their illnesses or post-
operative care while in their homes and arrange for the timely provision of the appropriate medicines.
Specialized fields also lend themselves to participation in the virtual medical world. The great distances
from the specialist centers to the smaller townships and the need for appropriate advice from specialists
makes this advanced communication a growing necessity. Via telemedicine, regardless of distance and
the availability of medical specialists on site, everyone will have access to necessary medical care and
advice. The cyberphysician and telemedicine will become essential elements in the health services of the
twenty-first century, particularly in rural areas and developing countries.

In addition to emergency hospital visits and routine health care, there are several fields of research which,
when applied to clinical problems, are poised to throw medicine leaps and bounds ahead of where it is
even today. The Human Genome Project uncovered the entire sequence of the genetic code for
humans, involving the identification of all the approximately 30,000 genes of DNA and the
determination of the three billion chemical base pairs of which it is composed. The result of this
research is an increased ability to diagnose and predict diseases and to develop new and effective means
of combating them. The next challenge for engineering is to devise novel and cost-effective approaches
to enable the benefits of this new knowledge to extend to individuals, whether to predict their susceptibility
to disease, to diagnose the nature of diseases or to treat them by genetic means. For example,
successful therapy may require the delivery of healthy genes into the individual cells within the patient's
body. A bioengineering technique that promises to make this possible involves localized exposure to
ultrasonic waves in the presence of tiny precision encapsulated gas bubbles which can make the cell
walls temporarily porous to the ingress of the genetic material.

A deeper understanding of the structure and function of the human body will be assisted by the
development of more and more powerful computers joined together by vast telecommunications
networks. Using such an extensive and powerful computer system will enable the development of a
conceptual model of the entire biological continuum of the human organism (that is, physiological
systems, organs, cells, proteins and genes) based on imaging and visualization information. The scale of
the information will range from the whole body (meters) down to the subcellular structures of which it is
composed (nanometers and less). The applications of such of model are unending; it would bring a
whole new dimension to diagnosis and treatment.

In addition to imaging models, other engineering methods, such as systems theory, control theory
and signal processing, will be used to build models of, for example, how cells communicate and
how they regulate the production of different proteins. Once the way in which cells function is
known, it may be possible to grow replacement organs and other body parts from an individual's own
genome. This would be a much more effective approach than current forms of tissue engineering.

Imaging techniques are aimed at seeing inside the intact human body. Generally, except for simple
X-ray equipment and ultrasonic scanners, the machinery is large and expensive and in almost every
case, the images can only properly be interpreted by medical experts. All are serious limitations. Current
research is concentrated in the areas of optical, electrical and magnetic imaging approaches, as well as in

2
seeking to extend the capabilities of the mainstream technologies, making them more efficient, cheaper
and easier to use. In current technology, the images are usually displayed as two-dimensional cross-
sections or as three-dimensional volumes. An important use of three-dimensional body imaging is in
incorporating biomechanical models of muscles and bones, enabling simulations of planned surgical
procedures. Thus, two particularly challenging possibilities for engineers are that a compact ultrasonic
scanner could be developed to fit in every doctor's pocket, alongside the stethoscope, and that the
current visual displays might be replaced by pictorial representations of what would be seen under direct
vision.

Another challenge for the future biomedical engineer is to bring all diagnostic procedures and
therapies to noninvasive or minimally-invasive procedures. Less invasive techniques and devices
will lead to more comfortable recovery for patients, as well as faster rehabilitation and shorter stays in
hospitals, all of which also lead to a reduction of health care costs. For example, in joint replacement
surgeries the goal is to minimize the trauma and the immediate postoperative complications and to extend
the life of the new joint so that it never needs to be replaced. The achievement of these objectives will
require the development of better techniques for accessing the diseased joint and performing the surgery,
more reliable fixation of the artificial joint and better mechanical reliability. It may even become possible
to dispense with mechanical artificial joints and to regrow the worn out joints by using the techniques of
tissue engineering or stem cell regeneration.

The intelligent systems and technologies in rehabilitation engineering represent a dynamic field which is
evolving tremendously. These rehabilitation systems are essential components in increasing the well-
being of people with disabling conditions around the world. The challenge for bioengineering will be to
further develop these technologies, which will include telemedicine, aids for people with visual, hearing
and speech impairments, artificial limbs, wheelchairs, tissue engineering for repairing brain damage after
stroke and for regenerating nerves after spinal cord injuries, and electrical devices for the maintenance of
continence.

While health care advances so quickly in the developed world, engineers must also address the issues of
the developing world. In addition to long-distance communication via telemedicine, a great potential
exists to improve diagnosis and therapy and to increase access to appropriate medicine and
technologies. The mainstay of diagnosis will likely still be simple X-ray and ultrasonic imaging, both of
which are relatively inexpensive but which need to be adapted for the local environment. The challenge is
to take present technology and create an affordable in-field version for greater ease of access.

Biomedical engineering has come a long way since Leonardo da Vinci (1452-1519) drew his revolutionary
pictures of the skeleton and its musculature and studied the mechanics of the flight of birds. The modern
era has seen the application of engineering in almost every branch of medicine, so much so that the
practice of medicine is now completely dependent on the work and support of engineers. The introduction
of electronic patient records, complex and extremely powerful electromedical equipment and devices, and
minimally invasive technologies is just the beginning. The future holds new possibilities of providing
telemedicine and e-health services, new ways of home self-care, sophisticated new sensors, and
new ways of heath care for older persons. In the preceding paragraphs, only some of the fields of
growth for the next generation were discussed; the pace of progress is accelerating and tremendous
challenges lie ahead for engineers working in this field. There seems to be no limit to what engineering
could do further to revolutionize medical practice. In fact, the next generation of biomedical engineers will
probably develop things we can’t even yet imagine.

Wow… can you imagine such a day … There will be such a day in Future …..Because of the Engineers...
we make the world.